Resumo
ABSTRACT: The aim of this study was to evaluate the postoperative analgesic effect of protocols with and without the opioid methadone in dogs with intervertebral disc extrusion undergoing decompressive surgery. Sixteen paraplegic dogs with preserved nociception underwent hemilaminectomy/disc fenestration and were randomly assigned to two groups. The analgesic protocol consisted of methadone, meloxicam and dipyrone in Group I (G1), and meloxicam and dipyrone in Group II (G2). The animals were blindly assessed by two observers, using the visual analogue scale (VAS) and the short-form Glasgow Composite Measure Pain Scale (CMPS-SF). Assessments occurred every 2 hours during first 24 hours post-surgery, and every 4 hours afterwards. There was no statistical difference among groups regarding pain scores or analgesic rescues. Both analgesic protocols provided analgesia in the initial 48 hours postoperatively, demonstrating that opioids are not necessary in the postoperative period of dogs undergoing hemilaminectomy and disc fenestration.
RESUMO: O objetivo deste estudo foi avaliar a analgesia pós-operatória de protocolos com e sem o opioide metadona em cães com extrusão de disco intervertebral submetidos à descompressão cirúrgica. Dezesseis cães paraplégicos com presença de nocicepção foram submetidos à hemilaminectomia/fenestração de disco e distribuídos aleatoriamente em dois grupos. No Grupo I (G1), o protocolo analgésico consistiu em metadona, meloxicam e dipirona e, no Grupo II (G2), por meloxicam e dipirona. Os pacientes foram avaliados de maneira cega por dois avaliadores, com base na escala visual analógica (EVA) e na escala simplificada composta de dor de Glasgow (CMPS-SF). As avaliações ocorreram a cada 2 horas durante as primeiras 24 horas de pós-operatório e, por mais 24 horas, a cada 4 horas. Não houve diferença estatística entre os grupos avaliados em relação à escores de dor e nem a necessidade de resgate analgésico. Ambos os protocolos promoveram analgesia nas 48 horas iniciais de pós-operatório, demonstrando não haver a necessidade do uso de opioide em cães submetidos à hemilaminectomia e fenestração de disco.
Resumo
The aim of this study was to evaluate the postoperative analgesic effect of protocols with and without the opioid methadone in dogs with intervertebral disc extrusion undergoing decompressive surgery. Sixteen paraplegic dogs with preserved nociception underwent hemilaminectomy/disc fenestration and were randomly assigned to two groups. The analgesic protocol consisted of methadone, meloxicam and dipyrone in Group I (G1), and meloxicam and dipyrone in Group II (G2). The animals were blindly assessed by two observers, using the visual analogue scale (VAS) and the short-form Glasgow Composite Measure Pain Scale (CMPS-SF). Assessments occurred every 2 hours during first 24 hours post-surgery, and every 4 hours afterwards. There was no statistical difference among groups regarding pain scores or analgesic rescues. Both analgesic protocols provided analgesia in the initial 48 hours postoperatively, demonstrating that opioids are not necessary in the postoperative period of dogs undergoing hemilaminectomy and disc fenestration.(AU)
O objetivo deste estudo foi avaliar a analgesia pós-operatória de protocolos com e sem o opioide metadona em cães com extrusão de disco intervertebral submetidos à descompressão cirúrgica. Dezesseis cães paraplégicos com presença de nocicepção foram submetidos à hemilaminectomia/fenestração de disco e distribuídos aleatoriamente em dois grupos. No Grupo I (G1), o protocolo analgésico consistiu em metadona, meloxicam e dipirona e, no Grupo II (G2), por meloxicam e dipirona. Os pacientes foram avaliados de maneira cega por dois avaliadores, com base na escala visual analógica (EVA) e na escala simplificada composta de dor de Glasgow (CMPS-SF). As avaliações ocorreram a cada 2 horas durante as primeiras 24 horas de pós-operatório e, por mais 24 horas, a cada 4 horas. Não houve diferença estatística entre os grupos avaliados em relação à escores de dor e nem a necessidade de resgate analgésico. Ambos os protocolos promoveram analgesia nas 48 horas iniciais de pós-operatório, demonstrando não haver a necessidade do uso de opioide em cães submetidos à hemilaminectomia e fenestração de disco.(AU)
Assuntos
Animais , Cães , Período Pós-Operatório , Cães/cirurgia , Analgesia , Disco Intervertebral , DipironaResumo
The aim of this study was to evaluate the postoperative analgesic effect of protocols with and without the opioid methadone in dogs with intervertebral disc extrusion undergoing decompressive surgery. Sixteen paraplegic dogs with preserved nociception underwent hemilaminectomy/disc fenestration and were randomly assigned to two groups. The analgesic protocol consisted of methadone, meloxicam and dipyrone in Group I (G1), and meloxicam and dipyrone in Group II (G2). The animals were blindly assessed by two observers, using the visual analogue scale (VAS) and the short-form Glasgow Composite Measure Pain Scale (CMPS-SF). Assessments occurred every 2 hours during first 24 hours post-surgery, and every 4 hours afterwards. There was no statistical difference among groups regarding pain scores or analgesic rescues. Both analgesic protocols provided analgesia in the initial 48 hours postoperatively, demonstrating that opioids are not necessary in the postoperative period of dogs undergoing hemilaminectomy and disc fenestration.(AU)
O objetivo deste estudo foi avaliar a analgesia pós-operatória de protocolos com e sem o opioide metadona em cães com extrusão de disco intervertebral submetidos à descompressão cirúrgica. Dezesseis cães paraplégicos com presença de nocicepção foram submetidos à hemilaminectomia/fenestração de disco e distribuídos aleatoriamente em dois grupos. No Grupo I (G1), o protocolo analgésico consistiu em metadona, meloxicam e dipirona e, no Grupo II (G2), por meloxicam e dipirona. Os pacientes foram avaliados de maneira cega por dois avaliadores, com base na escala visual analógica (EVA) e na escala simplificada composta de dor de Glasgow (CMPS-SF). As avaliações ocorreram a cada 2 horas durante as primeiras 24 horas de pós-operatório e, por mais 24 horas, a cada 4 horas. Não houve diferença estatística entre os grupos avaliados em relação à escores de dor e nem a necessidade de resgate analgésico. Ambos os protocolos promoveram analgesia nas 48 horas iniciais de pós-operatório, demonstrando não haver a necessidade do uso de opioide em cães submetidos à hemilaminectomia e fenestração de disco.(AU)
Assuntos
Animais , Cães , Período Pós-Operatório , Cães/cirurgia , Analgesia , Disco Intervertebral , DipironaResumo
Background: Ovariohysterectomy (OHE) is the most commonly performed elective surgical procedure in companionanimals. OHE offers benefits of control of population and decreased risk of potentially life-threatening diseases such asmammarian tumours and pyometra. Traditional OHE intervention causes inflammation and pain due to trauma duringorgan manipulation. The purpose of this study was to compare the effect of intraperitoneal and incisional administrationof bupivacaine (BP) or levobupivacaine (LP) on postoperative analgesia in dogs undergoing the OHE procedure.Materials, Methods & Results: A total of 24 mix-breed bitches aged between 1 - 3 years and weighed 19 - 20 kg wereused in this study. The animals were divided into three groups as control (n = 8), BP (n = 8) and LP group (n = 8). Theanimals were kept under surveillance at the hospitalisation unit of the animal hospital for one day before the elective OHE.The dogs were fasted for 12 h before the surgery, with adlib water consumption. Atropine sulphate 0.045 mg/kg was administered subcutaneously approximately 30 min before general anaesthesia. Midazolam (0.3 mg/kg) was intravenouslyinjected into all dogs for pre-anaesthetic medication. After sedation, anaesthesia was induced with propofol (4 mg/kg, IV)and then the dogs were orotracheally intubated using cuffed endotracheal tubes. General anaesthesia was maintained byadministration of 2% isoflurane. The ventral abdomen was prepared aseptically for OHE following the general anaesthesia.All animals were operated on by the same surgeon. During surgery, sprayed bupivacaine 0.5% (4.4 mg/kg) with an equalvolume of saline in BP group, levobupivacaine 0.5% (4.4 mg/kg) with an equal volume of saline in LP were then appliedover the ovaries, uterine broad ligaments and cervix uteri. After removal of the uterine body, either LP or BP was sprayedto left and right, or cranial and caudal parts of the abdominal cavity...
Assuntos
Feminino , Animais , Cães , Analgesia/métodos , Analgesia/veterinária , Bupivacaína/análise , Cuidados Pós-Operatórios/veterinária , Histerectomia , Injeções Intraperitoneais/veterinária , Ovariectomia/veterináriaResumo
Background: Ovariohysterectomy (OHE) is the most commonly performed elective surgical procedure in companionanimals. OHE offers benefits of control of population and decreased risk of potentially life-threatening diseases such asmammarian tumours and pyometra. Traditional OHE intervention causes inflammation and pain due to trauma duringorgan manipulation. The purpose of this study was to compare the effect of intraperitoneal and incisional administrationof bupivacaine (BP) or levobupivacaine (LP) on postoperative analgesia in dogs undergoing the OHE procedure.Materials, Methods & Results: A total of 24 mix-breed bitches aged between 1 - 3 years and weighed 19 - 20 kg wereused in this study. The animals were divided into three groups as control (n = 8), BP (n = 8) and LP group (n = 8). Theanimals were kept under surveillance at the hospitalisation unit of the animal hospital for one day before the elective OHE.The dogs were fasted for 12 h before the surgery, with adlib water consumption. Atropine sulphate 0.045 mg/kg was administered subcutaneously approximately 30 min before general anaesthesia. Midazolam (0.3 mg/kg) was intravenouslyinjected into all dogs for pre-anaesthetic medication. After sedation, anaesthesia was induced with propofol (4 mg/kg, IV)and then the dogs were orotracheally intubated using cuffed endotracheal tubes. General anaesthesia was maintained byadministration of 2% isoflurane. The ventral abdomen was prepared aseptically for OHE following the general anaesthesia.All animals were operated on by the same surgeon. During surgery, sprayed bupivacaine 0.5% (4.4 mg/kg) with an equalvolume of saline in BP group, levobupivacaine 0.5% (4.4 mg/kg) with an equal volume of saline in LP were then appliedover the ovaries, uterine broad ligaments and cervix uteri. After removal of the uterine body, either LP or BP was sprayedto left and right, or cranial and caudal parts of the abdominal cavity...(AU)
Assuntos
Animais , Feminino , Cães , Bupivacaína/análise , Cuidados Pós-Operatórios/veterinária , Analgesia/métodos , Analgesia/veterinária , Injeções Intraperitoneais/veterinária , Ovariectomia/veterinária , HisterectomiaResumo
O maropitant, antagonista de receptores de neurocinina-1, bloqueia a ação farmacológica da substância P no sistema nervoso central e periférico. Acredita-se que o receptor NK-1 esteja envolvido na modulação nociceptiva da medula espinhal e tenha ação analgésica segura. Objetiva-se comparar os efeitos antinociceptivo e cardiorrespiratórios do maropitant associado à cetamina e lidocaína em infusão contínua durante o transoperatório de cadelas submetidas à mastectomia radical unilateral. Foram utilizadas 24 cadelas, peso de 11,1 ± 9,0 e de idade 9,9 ± 2,9. Os animais receberam morfina (0,5 mg/kg/IM) como medicação pré-anestésica; indução anestésica com propofol (5 mg/kg/IV); e manutenção anestésica de isofluorano. Foram divididos em dois grupos (n=12) aleatoriamente e com os seguintes tratamentos: Grupo LK protocolo anestésico padrão: cetamina (1,0 mg/kg) e lidocaína (1,5 mg/kg), em bolus, e taxa de infusão de cetamina (10 mcg/kg/min) e lidocaína (50 mcg/kg/min); Grupo LKM protocolo anestésico padrão e maropitant (1,5 mg/Kg/IV), em bolus, e taxa de infusão de maropitant (100 mcg/kg/h). A infusão contínua foi iniciada no início da cirurgia e permaneceu até uma hora de pósoperatório. A temperatura corporal, frequência respiratória, saturação da oxihemoglobina, concentração de dióxido de carbono no ar expirado, concentração de isofluorano no final da expiração, frequência cardíaca, pressões arteriais sistólica, média e diastólica foram monitoradas durante o transoperatório nos momentos: M0: antes da medicação pré-anestésica; M1: antes do início do procedimento cirúrgico; M2: após incisão do subcutâneo; M3: retirada da cadeia mamária; M4: aproximação do subcutâneo; M5: sutura de pele e M6: fim da cirurgia. A avaliação de dor pósoperatória foi realizada por meio das escalas: Escala Descritiva Simples; Escala Analógica Visual Interativa e Dinâmica; Escala de Classificação Numérica e Escala Composta de Glasgow Modificada. Na avaliação do limiar nociceptivo mecânico, utilizou-se analgesímetro digital. Os resultados foram avaliados pelo Teste t-Student, Teste de Mann-whitney, Friedman e Teste de logrank para a curva de Kaplan-Meier. Houve uma redução do escore de dor, maior taxa de sobrevivência com menor número de resgate analgésico e redução na sensibilização periférica no grupo LKM comparado ao LK. Além disso, nota-se uma redução na pressão arterial no grupo LKM em relação ao LK, mantendo-se os demais parâmetros estáveis. Acredita-se que a utilização de protocolos multimodais melhore o conforto do paciente e diminua os efeitos adversos dos medicamentos Conclui-se que a associação do maropitant a cetamina e lidocaína teve efeito adjuvante com mínimos efeitos cardiorespiratórios e boa analgesia, promovendo controle da dor e maior conforto ao paciente.
Maropitant, a neurokinin-1 receptor antagonist, blocks the pharmacological action of substance P on the central and peripheral nervous system. It is believed that the NK- 1 receptor is involved in the nociceptive modulation of the spinal cord and has a safe analgesic action. The objective of this study was to compare the antinociceptive and cardiorespiratory effects of maropitant associated with ketamine and lidocaine in continuous intraoperative infusion of bitches submitted to unilateral radical mastectomy. Twenty-four bitches were used, weight 11.1 ± 9.0 and age 9.9 ± 2.9. Animals received morphine (0.5 mg / kg / IM) as preanesthetic medication; anesthetic induction with propofol (5 mg / kg / IV); and isoflurane anesthetic maintenance. The LK group - standard anesthetic protocol: ketamine (1.0 mg / kg) and lidocaine (1.5 mg / kg), bolus, were randomly divided into two groups (n = 12) and with the following treatments: ketamine infusion (10 mcg / kg / min) and lidocaine (50 mcg / kg / min); LKM group - standard and maropitant anesthetic protocol (1.5 mg / kg / IV), bolus, and infusion rate of maropitant (100 mcg / kg / h). Continuous infusion was initiated at the beginning of the surgery and remained until one hour postoperatively. Body temperature, respiratory rate, oxyhemoglobin saturation, carbon dioxide concentration in the exhaled air, end-expiratory isoflurane concentration, heart rate, systolic, mean and diastolic blood pressures were monitored during transoperative times: M0: before preanesthetic medication; M1: before the beginning of the surgical procedure; M2: after subcutaneous incision; M3: removal of the mammary chain; M4: subcutaneous approach; M5: skin suture and M6: end of surgery. The evaluation of postoperative pain was performed through the scales: Simple Descriptive Scale; Visual Interactive and Dynamic Analog Scale; Numerical Classification Scale and Modified Glasgow Composite Scale. In the evaluation of the mechanical nociceptive threshold, a digital analgesimeter was used. The results were evaluated by Student's t-Test, Mann-whitney test, Friedman and Logrank test for the Kaplan-Meier curve. There was a reduction in pain score, higher survival rate with lower number of analgesic rescue and reduction in peripheral sensitization in the LKM group compared to KL. In addition, there was a reduction in blood pressure in the LKM group in relation to KL, with the other parameters remaining stable. It is believed that the use of multimodal protocols improves patient comfort and decreases the adverse effects of medications. It is concluded that the association of maropitant with ketamine and lidocaine had an adjuvant effect with minimal cardiorespiratory effects and good analgesia, promoting pain control and greater comfort to the patient.
Resumo
Neste estudo foi avaliada a eficácia analgésica da cetamina, administrada em três diferentes regimes de infusão intravenosa contínua (IC), em cadelas submetidas a mastectomia unilateral. Foram incluídas no estudo 24 cadelas, distribuídas em três grupos denominados: grupo infusão contínua transoperatória (CONTROLE, n=8), nas quais a IC da cetamina foi administrada somente durante o período transoperatório; grupo infusão contínua de 12 horas (IC12, n=8), as quais receberam a IC durante o período transoperatório e 12 horas após o término da cirurgia; e grupo infusão contínua de 24 horas (IC24, n=8), as quais receberam a IC durante o período transoperatório e 24 horas após o término da cirurgia. Os parâmetros cardiorrespiratórios foram avaliados durante o período perioperatório e aanalgesia pósoperatória foi avaliada de acordo com as escalas análoga visual interativa (VASi) eComposta de Glasgow(GCPS-SC). As avaliações foram realizadaspor dois pesquisadores 10 minutos, 2, 4, 6, 8, 12, 18 e 24 horas pós-extubação.Os proprietários avaliaram seus animais por meiodoHelsinki Chronic Pain Index no 4º e no 10º diasapós o procedimento cirúrgico. Os escores de dor e o requerimento de morfina no período pós-operatório não diferiram estaticamente entre os grupos. O resgate analgésico foi administrado em 7/8, 7/8 e 6/8 animais nos grupos CONTROLE, IC12 e IC24, respectivamente. Os principais efeitos adversos da IC de cetamina observados foram taquipnéia e hipertensão. Na avaliação dos proprietários os grupos IC12 e IC24 tiveram menores escores de dor no quarto e no décimo dia de pósoperatório. Concluiu-se que, apesar de poder ocasionar efeitos adversos discretos, a IC de cetamina é eficaz como adjuvante no fornecimento de analgesia no período pós-operatório imediato, maso principal benefício de seu uso provavelmente esteja relacionado com melhor recuperação e qualidade de vida no período pós-operatório tardio.
This study evaluated the analgesic effects of ketamine administered by three intravenous continuous infusionprotocols (IC) in bitches undergoing mastectomy. Twenty-five bitches were distributedrandomly in three groups: intraoperative continuous infusion group (CONTROL, n=8), receiving the IC only during the intraoperative period; 12-hour continuous infusion group (IC12, n=8), receiving the IC during the intraoperative period and for 12 hours after surgery; and 24-hour continuous infusion group (IC24, n=8), receiving the IC during the intraoperative period and for 24 hours after the surgery. Cardiorespiratory evaluations were performed during the perioperative period, and two researchers evaluated the postoperative analgesia by the interactive visual analog scale (VASi) and by the Short form of Glasgow composite pain scale (GCPS-SC), 10 minutes and 2, 4, 6, 8, 12, 18 and 24 hours after extubation. Owners evaluated their dogs using a questionnaire adapted from the "Helsinki Chronic Pain Index" on the 4th and 10th daysafter the surgical procedure. Pain scores and postoperative opioid requirements did not differ among groups. Rescue analgesia was administered to 7/8, 7/8 e 6/8 bitches in CONTROL, IC12 and IC24 groups, respectively. The main adverse effects observed were tachycardia, tachypnea, hypertension and excitement. According to the owners criteria, the animals of IC12 and IC24 groups had lower pain scores on the 4th and 10th days after the surgical procedure. We concluded that, although some mild adverse effects could occur, IC of ketamine is an effective and safe analgesic adjuvant in the early postoperative period. However, the main benefit of the prolonged Ketamine IC is probably related to the best quality of life andrecovery in the last postoperative period.